When I was planning for Mikko's birth, the question came up: Who would be present during the labor?

I was planning a home birth, and I was seeing two midwives for prenatal care. One would be present during the birth, along with one or more student midwives.

I had already decided, then, not to birth entirely alone, so I needed to choose who else, if anybody, would be present. My options were my husband, other family members, a paid doula, or some combination of the above.

I seriously considered the options of family members and a doula, but in the end I chose only Sam as my birth partner. I'll present my reasons and my conclusions about my choice, in case it helps anyone else in the decision process. If you resonate or disagree with any of my reasoning, that will tell you something about what choice you might feel most comfortable with.

[NB: Sorry in advance that this is looong. You can skim for the bolded bullet points to find interesting bits to read if you're so inclined! I'm a completist; what can I say?]

• I knew for sure that I wanted Sam with me. I know that for some women, men — or anyone — in the room with them can be a distraction. For me, Sam is my rock and the person I'm absolutely most comfortable with. I'm a very reserved, introverted person. With anyone else in the world, even if I'm enjoying the company, I just have to bolt now and again, because it gets too much. If you invite me to a party and you can't find me, I'm probably in the loo taking a breather — or I left early. Before I married, I worried that I would get that same overwhelmed, trapped feeling with my partner — and I never have. Being with Sam is like being with myself. Only better. So he was staying, I knew. That left family and doulas to consider.

• The next easiest but most emotionally wrenching part of the decision process was choosing not to invite any other family members or friends to be present. I didn't have any who were supportive of home birth or midwife-assisted birth, and I knew I didn't want negativity and second guessing swirling around me. This was disappointing, because in the back of my mind, I had long assumed my mother would be present at my birth. I knew she could have been a strong advocate for me in the event of a hospital transfer (which is, in fact, what happened), but only if she was on board with my wishes, and I felt that she was uncomfortable with them.

• I think if I have a second or subsequent birth that having a relative or friend present to care for the older sibling(s) could be helpful, so I'm going to keep that in mind. I would love for Mikko to be present for his sibling's birth if he wanted to be, but I'm rational enough to know that watching someone moan and shut her eyes for 42 hours could get a wee bit boring for a young child. Even the midwives took naps during that! So having someone he was familiar with on hand would be a lifesaver in terms of taking him away to refresh, but staying near enough that he could be brought back when needed. However, since this was my first birth, that wasn't necessary. My cat handled herself just fine without a sitter. (I actually did wonder how she'd do — she couldn't have cared less!)

Deciding whether or not to hire a doula was more of a process. I talked it out on message boards, listened to my midwives' advice (they said to get one), and asked Sam probing questions to determine his fitness to support me in a doula-free environment. We decided against a doula, for these various reasons:

• First of all, we were planning a home birth with midwives. If we had been planning a hospital birth, or a birth with an OB-GYN physician, or even a birth center birth, I absolutely would have, no questions asked, hired a doula. I would need a strong advocate in a situation where intervention was a high likelihood. I would want someone to be my voice for me. Sam is great at speaking to me and supporting me personally, but neither of us is very outspoken at demanding our rights or defending our wishes. As it was, though, we were planning a low-intervention birth, and we trusted our midwives, whom we had seen throughout the pregnancy, to honor our wishes during the birthing time. Sam and I didn't feel like we would be fighting against them, so another advocate seemed unnecessary.

• Now, if we transferred to the hospital — as we did — our insurance would no longer cover the midwives as caregivers, and we would switch to a set fee. The good thing about the fee is that it meant the midwives would come to the hospital with us to serve as doulas and advocates. This is in fact what happened, and they were great with that. They were able to speak with the staff about my laboring background and my current progress; they argued with the nurses about all the monitoring and questions (they lost some of these arguments, but it saved me the energy of trying and failing!); they were able to secure the best nurse-midwife to attend, because of their relationship with her; after the birth, they reminded me and supported me in my decisions not to have, for instance, the Hep B shot for Mikko, my non-drug-using, non-promiscuous newborn; they reassured me that the cord was cut after it stopped pulsing; and...they took pictures! Both still and video. Sam and I had long stopped thinking about documenting this incredibly long labor, but we so appreciated after the fact that we had footage of the beautiful natural birth.

• I mentioned that I'm shy and not so great with strangers. Even having the midwives attend at my own home made me nervous that I'd clench up my sphincter muscles and not be able to birth unencumbered. As it turned out, I went so far into Labor Land that modest ol' me was often totally nude in front of the various midwives and midwifery students and didn't care a whit. But I was nervous about finding a doula I could feel as comfortable and free with as I felt with Sam (well, or nearly so — I wasn't looking for perfection!). It seemed like a daunting task, even harder than our series of midwife interviews. The midwives were with us through part of the labor, but spent much of their time in the living room while Sam and I dominated the bedroom and I took long showers in the bathroom. But I had the understanding that a doula would be there, close to me, the whole time, and I was so afraid that I would choose someone I couldn't after all stand! I don't know how reasonable this fear was, just that it seemed safer to leave well enough alone.

• One reason I wanted to make sure I wasn't being pestered by someone throughout the labor was that I was using Hypnobabies as my birthing technique. To enter that state of focus, I needed peace and the freedom to go inside myself. I had a horrible vision of a doula who wouldn't stop talking. Indeed, one of our midwives was more talkative than the other, and Sam and I worried that if we drew her for the birth that she might be too distracting. She actually was the one on call, and it turned out to be totally fine. She was very serene and stayed out of the way. So I might not (probably would not) have had to worry about that with a doula, either. If I had hired a doula, I would have wanted one who was familiar with or at least positive toward Hypnobabies or childbirth hypnosis. If the midwives had been negative toward hypnosis — well, first of all, we wouldn't have hired them! But if I had sensed reservations, I might have hired a doula supportive of hypnosis to counter that; however our midwives were completely enthusiastic about hypnosis and said it always made for calm mamas. If we had hired a doula, we ideally would have hired one who was trained in Hypnobabies in particular and who could have helped me stay under hypnosis and use trigger words to relax me further. However, Hypnobabies doulas are harder to find, and they sometimes charge more.

• That leads me to the monetary point. Sam and I are not and were not rich. Doulas were a hefty cost that was not covered by our self-employed health insurance. I think they should be, because positive labor support has an incredible effect on healthy birth outcomes. But even though doulas generally undercharge for their amazing care, affording to pay a doula can be out of reach of some mamas.

• I had to ask myself what I wanted a doula to accomplish, and then I turned around and asked Sam all the same questions, to see if he would commit to be up for the task. Our midwives and I encouraged him to read The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions, by Penny Simkin, and I shared with him nearly all the knowledge I had gleaned about childbirth through reading countless books, magazines and websites, and even had him watch some YouTubevideos with me! He also had his own birth partner Hypnobabies CD to listen to, to help relax and empower him. We practiced various hypnosis techniques together, and he learned a trigger word to put me into deep relaxation. After he had a chance to absorb some of this material, I went through The Birth Partner's checklist for birth partner preparedness. I asked him if he would be supportive and positive throughout the labor, if he could handle any fluids or yuckiness (I threw up multiple times and bled a lot after, so it's wise I checked!), if he could provide physical support despite lack of sleep (he pressed on my back through almost every contraction, bless him!), if he could NOT PANIC even if I was (this was crucial!), if he could handle seeing his wife's genitalia looking very odd and very exposed indeed, if he could manage nitpicky details like heating water for the birthing tub and setting out snacks while also attending to me, if he could advocate for me when I was unable to express my wishes, and if he could care for himself as needed while he cared for me. I didn't need him passing out from lack of food or sleep! Sam agreed thoughtfully to each point. It really was a monumental task, and he performed it with aplomb.

• One final test in making our choice was considering what Sam wanted. Yes, ultimately I was the one giving birth out of my body, but it was Sam's experience, too, and I respected and honored his wishes. Also private and uncomfortable around near-strangers, Sam felt wary about having another guest in the house. He particularly didn't like the idea of a support person who would be closer to me than he was. He feared that his place by my side would be usurped by a strange woman. In his shoes, I would have feared the same thing, so this was the clinching argument.

All right, those were our reasons not to hire a doula or have family present at our birth, but to have Sam act as full birth partner.

• I still feel guilty that I didn't invite my mother to be present at her only daughter's first birthing time. It's not that she asked and I declined; I just never spoke of it. But I always wonder if she was hurt by the omission. I console myself by considering her as first choice to be the point guard for Mikko in any future birth. I still believe any outside negativity or concern would have been unhelpful in Mikko's long, uneventful labor, and Sam did not want her present in any case, so despite my emotional regrets, I know I made the right decision.

• For hiring a doula, I don't know. If I were to do a first birth over again, I might hire one, but start looking for her early to ensure that we found a good fit and could get to know each other as friends before the birth.

• For a subsequent birth, I feel more prepared and knowledgable. That said, there are aspects that I don't think Sam and I did so well on that a doula might have or would have improved:
For instance, I threw my regimented Hypnobabies techniques out the window and just basically focused on relaxing and staying calm. This worked — don't get me wrong — but it might have worked even better if I'd had a Hypnobabies doula who could keep me on track. I don't remember Sam ever using our trigger word or hand gesture or scripts as we had practiced (is this true, Sam? I was so out of it that I might just be blanking).
In general, I felt like Sam was sort of skimming all the information I was throwing at him about birth but that he wasn't passionate about it like I was. That might be an unfair characterization, but it's how it seemed to me, whereas I could be confident that a doula would have been wholly devoted to and knowledgable about birthing.
Sam held up through the long labor like gangbusters, snatching naps in between waves just as I did, but he might have appreciated a longer spell now and again; I'd have to ask him.
The most significant reason I'd consider hiring a doula for a do-over or for next time is that, true to my expectations, Sam and I are crap at standing up for ourselves. We each did our best, but being tongue-tied people pleasers, we just are not very good at that sort of thing.
I mentioned that we trusted our midwives, but still there were things that happened that were less than our ideal. For instance, I had fully expected to refuse all internal exams due to their depressing nature — but I had several at the behest of the midwives. They all said I was at 5 cm. The.whole.time. Like I said, depressing. I felt churlish and out of line at the thought of refusing, and so I didn't. A doula who knew of my preferences might have spoken up (and wrestled the midwives to the ground?).
When the talk came of hospital transfer, the reason given was "You've been at 5 cm for 35+ hours of back labor; if this continues at the same rate, you might become exhausted, so maybe it's best to transfer now, get some Pitocin, an epidural, and some rest, so that you can be fit to push when the time comes." I didn't feel exhausted, because I had been napping in between contractions. I was dehydrated from the vomiting and running a slight fever, but the midwives had given me a couple bags of IV fluid to compensate. Sam tried to talk me out of the transfer, but at that point I was too low emotionally to fight it. We were onto our third potential date for what might be our baby's birthday, and still there was no sign of his imminent arrival. The grim prediction that, because I had been at 5 cm, I would stay at 5 cm into perpetuity just wore me down.
As it turned out, Sam was right: I felt the urge to push in the car, and I had our baby naturally a scant few hours after arriving in the hospital. But in that moment, facing his weary and depressed wife and feeling not a little weary and depressed himself, Sam did what any good husband would do: He gave in to make me happy.
I wonder if a doula would have fought the midwives harder on that one, too, and gone harder toward cheering me up and on. In this imaginary scenario, I'm considering doulas to equal something like a mother bear. Whether they are this way, I do not know.
After the birth, too, faced with pushy nurses armed with formula bottles, we could have used just such a fierce advocate, but I don't know if even the doula would have been around at that point. All of which leads me to believe that Sam and I simply (and difficultly) need to become better at advocating for ourselves. I do feel more prepared for next time, and I trust Sam does, too.
I think one problem was that our natural reticence and the calm demeanor induced by Hypnobabies made it hard for our midwives to gauge my emotional state and my physical capacity in any given moment. I was too soft-spoken and engaged in labor to try to explain myself. I don't know that having a doula would help any with this, unless she was psychic (I kid) or could intuit my feelings very well. If I did find such a doula, though, that would be invaluable for being a filter between the healthcare professionals and me. The home-birth midwives, although they were low-intervention in comparison to MDs, still had to consider persky things like malpractice suits and medical responsibility. An astonishingly adept doula could have played ambassador and interpreter between the two sides. However, I don't know if I would be able to open myself up to a doula, either, so this might be a moot point.
One not-very-important point, but a small regret for my archivist heart and one I wish to rectify in the future, is that we took very few pictures during the labor. I know some doulas are professional photographers, and some are eager amateurs. Sam and I felt too alternately drained and focused to wish to document the labor, so having someone on hand whose job it was might have been nice after the fact. That said, there are other options we could consider, like a time-lapse video set up in one corner.

Let me just say that I mean no disrespect toward doulas based on our choice. I am actually so interested in birth that I considered going back to school to become a midwife, and when that seemed daunting, realized that becoming a doula one day might be a more manageable dream!

So, those are our reasons for choosing solely a spouse as birth partner, and the outcome. Who was with you during your birth, and why did you choose the companions you did? How did their support help, and what would you do differently next time? (Please answer in essay form, and neatness counts.)

(Just joking. But you can seriously answer the questions. I'd love to hear!)

Remember to check Science & Sensibility for the links to the other Healthy Birth Blog Carnival entries starting Nov. 30.

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comments:

I've had 2 straightforward midwife attended home births, both labors fairly short. At my first, my mom and husband were present. My mom was there more for her than for me. I didn't really care one way or the other. She supports home birth. At my second, only my husband was present. He was present in the room during labor but doing his own thing, at my request. My mom was caring for my older child at her house. I was sort of planning to have my toddler present, but when my midwife arrived, I was 10 cm (had no idea). In retrospect, I would have liked to have my 2 year old present at my second birth. In the future, I will probably have my husband, children, and a caregiver for my children (and the midwife of course). I want my husband there because it is his baby, too and he still talks about how he was the first person to touch our first baby since he caught. With the second, he was supporting me in a squatting position so he was not able to catch. I generally just like to be left alone in first stage with my husband in the room doing something else (like playing computer games), with the midwife and my husband helping during second stage.

Lauren, I felt much the same ways you expressed. My husband was the only support person to attend each of my three births. My oldest two daughters attended the birth of their little sister and I'm so glad they did. They were old enough at 6 and 3.5 that we felt they did not need another caregiver present and they did extremely well.

The only thing that gives me pause about my decision is that I think every woman should have the opportunity to witness a safe, intervention-free birth before she gives birth herself. I wish I had had that opportunity. Knowing that millions of women have gone through labor and delivery is not the same as witnessing just one woman give birth. I wonder, do we have the responsibility, or maybe a better word is privilege, of sharing the birth experience with other mothers-to-be?

I had only my husband present at both of my births, and I would do it that way again. My husband is a very good support person, and rises to the occasion. I can't imagine anyone else would do a better job for me than he did.

I am also vaguely annoyed by people who suggest that men shouldn't be present at the birth. I've heard various reasons, and maybe for some men it really doesn't work. But I would never exclude my husband from being present as his children entered the world without a really good reason. I also sort of feel like I wouldn't let him off the hook - we went into it together, and he needs to help me through it. ;)

I think your choices for who attended your birth were totally well-reasoned and valid! As a doula I feel that I need to interject that a doula should not advocate for a client. However, during prenatal preparations, a client can learn a LOT from a doula on the topic of being her own advocate and having her partner advocate for her.

For my first birth, my husband was there, and it was an ob/gyn hospital birth so... the L&D nurses popped in once in a while, I guess -- I unfortunately don't remember much. That birth ended, not surprisingly, with a c-section.

My second and third births were in the hospital with a (male) midwife. My husband was my again my birth partner. Even though by the time my third child was born I was a doula myself, I chose not to have a doula. I knew that I would be too inhibited laboring with a peer attending my birth.

Like you, I have mixed feelings about my mother not attending my birth. I really know that it would not have been a good move for me but I wish we had the relationship in which it would've worked.

I'm glad to hear that other people think I made the right decision, too, and that you've had similar experiences. I had this fear when writing it, probably because of a lot of pressure to hire a doula when we were planning the birth (from the midwives and the Hypnobabies forum), that doulas would get mad at me for suggesting that not hiring a doula was a valid choice. It sounds like, for those of us here, that our husbands are the type of person we want to have around. I could see some men being a really bad addition to a birthing room — but I could say the same of some women!

Michelle: That's a good idea to have your husband present and quietly supportive but not interfering when you just need time alone.

Angela: I wonder if that's part of my dream of being a midwife, to witness more births than I can possibly have myself? There's something so beautiful about the variety.

Amber: Not letting him off the hook! Exactly. :)

Karen: I'm so glad to hear a doula charm in, and I would love to hear more of your experiences with a male midwife. My NaNoWriMo novel this year was almost about a male midwife, but then I changed it at the last minute. (Random...you can ignore me.) That's really interesting to think of the pressure of having a peer attending your birth if you had hired a doula. That makes so much sense. And thanks for explaining that doulas should not advocate, because then that makes my decision that much more valid for us. I hope we do learn how to advocate for ourselves better, though.

Speaking of which, here are some additions/rebuttals from Sam! He read it but seemed hesitant about logging on to comment, so I'll just present his views here and hope I do a better job speaking for him this time. :)

First of all, his memory of the decision to do the hospital transfer was not that he was trying to talk me out of it but that he was for it but trying to make sure I agreed. He says he was concerned that I wasn't able to keep anything down, and the midwives had already used both of their IV fluid bags. He (we) thought that I might end up having to transfer later in any case for more fluids, which could end up being an emergency transfer or a post-birth transfer, in which case Mikko & I would have been separated. The option to calmly transfer in our own timeframe seemed like the better choice. I've second guessed and what-if-ed our decision to death since then, but ultimately since I can't know what would have been, I believe we probably made the right decision to transfer.

Secondly, he said that he didn't know I wasn't using my hypnosis techniques because I was so calm and quiet throughout. He was saving the triggers for when I panicked, but I didn't. In retrospect, this makes perfect sense: How can you tell when a calm, quiet person isn't fully hypnotized? Now, a hypnodoula might have been more proactive about using scripts and making sure I stayed in hypnosis. But, you know, I got through 42 hours of back labor without medication, so I guess whatever I did worked out OK. I used to blame myself for not being more of a good hypnostudent, but I'm more at peace with that now.

Thirdly, while Sam's sure he doesn't know as much about birth as a doula, he approached learning about birth with studied casualness because he didn't want to worry me by being all frantic & "Oh, noes, I don't know anything about birth! We must learn it all NOW!" The idea was that birthing was natural and normal, and he was trying to reinforce that by being calm about it in advance.

So there you are: Sam's take on my take on Sam! He should really comment more often.

I think the whole you-need-an-advocate is soooo crucial. whether it be a doula or midwife or smart ass relative, someone who shares your philosophy and knows the system is critical for a new mom in the heat of labor.

I had two homebirths. both with a midwife and my hubby in the next room and my cat in the bedroom with me watching over me. I wanted to be completely alone. no eyes, no worries just focusing in on my body, the baby and the birthing canal...

Hubby was indispensible however. He was like a invisible elf, sneaking in to leave me freshly peeled and sliced apples in a bowl of ice water, extra tissues, water. He'd fill the tub with hot water when I'd ask. he was so cool and efficient even though he said (later) he was shitting bricks inside.

He and the midwife came in for when I was ready to push. They were great. and it was great having people there once the baby was born. that's the time you want to be surrounded by your loved ones.

My midwife helped me shower and hubs made me a huge plate of fettucine with mushroom sauce to eat in bed a few hours later. My mom flew in 2 days later. It was heaven.

I, too, am obsessed with birth(s) but I have considered teaching the coping method I prefer. Now that you mention it, Doula might be a great route... I need to check into that! I am such a hard core naturalist, though, that I'm not entirely sure how well I would do if I had a client who's opinions didn't mirror my own.

Anyway, my experiences:

My first born was Lamaze, hospital birth, with my step mother as a coach. It went smoothly. No epidural. I didn't really have a choice about my coach at the time (I was 17yo).

My second, I thought I'd want my best friend, but she was seeming terribly flighty. I was right not to choose her, considering she didn't even visit me in the hospital. I chose Bradley method and my husband as a coach. Again, hospital birth, natural delivery. My mother and sister were there for labor, but not delivery.

Now with my 2nd husband, I chose Bradley again and went to classes again (new coach and I needed a refresher anyway). I also invited my mother into the delivery room. I wanted my husband to have backup in case he needed a break. Mostly she was just support. She was very touched by witnessing our birth and I wouldn't change that for anything, either.

I considered the idea of Doulas with both of these last births, but I was certain both times that I could NOT afford one.

Oh, I could go ON and ON and ON about my births and it is one of my favorite topics to share, but suffice to say that I am satisfied with the choices I made. I, however, am the strongest advocate in my family, often times having to step in on their behalves.

You made the choices that were right for you and you should be proud of advocating to that point. Some can't even do that. Your birth experience is about YOU, not what others want (other than considering your husband, which I think was also the right way to go!).

Shut up now, Jorje, you're rambling!! (I had to shorten this post to get it to go.)

I had my husband be my birth partner because there really weren't any other people nearby I could have had with whom I felt comfortable enough with to share such an intimate experience. I did want one particular girlfriend be there for me but she lives a country away and in the end couldn't make it. Anyway, I actualy had a lot of anxiety over whether or not my husband could pull it off for me or not. I had major insomnia and panic attacks about him disappointing me the weeks leading up to the birth. It was awful. In the end he did a great job. For my first birth I wanted a doula even though it was a plnned homebirth. After interviewing about 7 women (I was SO picky!) I found the perfect woman and she was free! Doulas need to attned three births before they can charge and our birth was to be her first. In the end, I had an emergency CS and we didn't call her because she wouldn't have made it to the hospital on time anyway, and what would she have done for us if she had gotten there? There was nothing she could have done. We had our midwife present and that was all we could have asked for. She was amazing. I wish I had known about this Carnival earlier. Oh well. Next time.

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Riding the rails with my husband, Crackerdog Sam, and our hobo kids, Mikko Lint Picker (born June 2007), Alrik Irontrousers (born May 2011), and Karsten (born October 2014). Trying every day to parent intentionally and with grace.